A woman had a copper intrauterine contraceptive device (IUCD)
inserted by a family planning clinic. Around five months before the
IUCD was due to be removed, the woman presented to her GP medical
centre. She received treatment for bacterial vaginosis (BV), and
advised the nurse that she had an IUCD in place, which was due to
be removed. The nurse recorded this in the woman's clinical
notes.

The woman saw her GP at the medical centre about a month later.
She recalls telling the GP that she had an IUCD in place. The GP
said she did not ask the woman about contraceptive use and history,
and was not aware the woman had an IUCD in place. The woman
enquired with the medical centre about Mirena (a different type of
intrauterine system) as an option for management of heavy menstrual
bleeding. Her GP arranged special authority for a Mirena.

The woman attended an appointment with her GP to have the Mirena
inserted. The GP performed pelvic and speculum examinations, and
told HDC the results of these assessments were normal and there
were no strings from an existing IUCD visible. The GP did not
remove the existing IUCD before inserting the Mirena.

The woman attended a follow-up appointment and her GP performed
a vaginal examination and noted the Mirena was in place. The woman
attended a further follow-up appointment with another GP at the
medical centre who performed a vaginal examination and noted the
Mirena was in place. The woman had recurring BV which was treated
with antibiotics.

The following year, an X-ray was taken of the woman's back
following a fall. This revealed two contraceptive devices in her
uterine cavity. The woman returned to her GP who removed both
devices and noted that the strings from two contraceptive devices
were seen on examination.

It was held that the GP breached Right 4(1) as she did not
adequately assess the woman's contraceptive history prior to
inserting the Mirena. Further, the GP failed to read the nurse's
note stating that the woman had an IUCD in place, and failed to
consider alternative causes of the woman's heavy menstrual bleeding
and BV. The GP breached Right 4(2) for failing to keep adequate
clinical records. The GP's failures were matters of individual
clinical judgement and the medical centre was not responsible for
them.